Organization
IBL SPECIAL CARE MANAGEMENT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAMANTHA ANN ROACH (ADMINISTRATOR)
(225) 291-3123
Entity
Organization
Contact information
Practice address
11616 SOUTHFORK AVE, STE 204, BATON ROUGE, LA 70816-5241
(225) 291-3123
(225) 291-3069
Mailing address
14241 COURSEY BLVD, STE A12167, BATON ROUGE, LA 70817-1368
(225) 291-3123
(225) 291-3069
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
PCA 15172
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PC0007839
—
LA
Enumeration date
01/21/2009
Last updated
02/04/2009
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